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Alterations in CAPOX Regimen and Neuropathy

By: Celeste L. Dixon
Posted: Friday, March 13, 2020

In the adjuvant setting for colon cancer, CAPOX—the combination of capecitabine and oxaliplatin—can have the adverse effect of peripheral sensory neuropathy. However, providing oxaliplatin intermittently rather than continuously after surgery may reduce the incidence of this neurologic side effect and its effect on patients without impacting survival, according to Masanori Nakamura, MD, of Konan Kosei Hospital, Japan, and colleagues. Their findings were presented at the 2020 Gastrointestinal (GI) Cancers Symposium in San Francisco (Abstract 95).

The randomized phase II study included 200 patients who had undergone curative resection of stage II or III disease. The investigators reported that although the difference in 3-year disease-free survival was not significant between the continuous versus intermittent arms (78% vs. 82%, respectively; P = .49), peripheral sensory neuropathy frequency at 1 year after surgery was 58% in the continuous arm and 19% in the intermittent arm (P < .01). Those calculations were the trial’s primary endpoints.

Additionally, the frequency of peripheral sensory neuropathy 3 years after surgery was 37% versus 9% in the continuous and intermittent arms, respectively (P < .01). In patients with stage III colon cancer alone, the 3-year disease-free survival rates were 76% and 80% in those arms, respectively (P = .43).

Patients in the continuous arm received eight cycles of CAPOX. Those in the intermittent arm had two cycles of CAPOX followed by four cycles of capecitabine, then two more cycles of CAPOX. The study results indicate, noted Dr. Nakamura and co-researchers, that the intermittent regimen has strong potential to improve patients’ quality of life without diminishing the adjuvant treatment’s desired effect.

Disclosure: The study authors’ disclosure information can be found at coi.asco.org.



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